So let's get started talking about or understanding your headache. Headaches are classified into two types of categories. The first is the primary headache conditions in which there is no underlying organic medical condition that needs to be treated and the second. Is, the secondary headaches where there is an organic cause that needs to be treated. As you can see from this, slide. Some of these causes can be very serious and need appropriate medical care. When I talk about that there is no underlying organic cause that needs to be treated, I'm not talking about there isn't. Real physiology, real pain and real problems. It's just that the focus of care with the primary headache conditions is on the headache itself, where as the focus of care secondary disorders are on the underlying condition. Migraine. Tension type headache, and cluster headache are your, the three classic primary headache conditions. Today I'm going to focus on the first two, which are by far the most common. When we look at the epidemiology of the primary headache disorders, 90% of the population experiences headache. During their life. About 40% of people will seek medical attention for headache sometimes during their life. About 15 to 20% of women, five to ten percent of men, and roughly five percent of children get frequent headaches. Five to ten percent will receive chronic care. For their condition. So, how do we diagnose a primary headache disorder? It starts with a detailed history and examination. And if there are no particular red flags identified. Then we will in the pattern fits we will come up with a diagnosis of a primary headache disorder if there are particular red flags then the patient will require a more in depth evaluation and testing to determining the exact cause of the headache. Ocassionaly there are people with no red flags that have a typical pattern of a primary headache disorder but they have a few a typical features and these a typical features make us proceed down a path of an evaluation. First before we give them a diagnose of a primary headache disorder. Snoopp. Is the mnemonic that we use to separate out the or to come up with a red flags for headaches. You can see these different factors are divided into either patient factors, such as systemic factors such as the person appears ill or has a fever. Or they're particular age or they have certain risks from other diagnoses, such as they're immuno compromised have a history of cancer or on cumadin. So there are those patients characteristics that make us worried that people need to be evaluated. The second is the headache itself. The people have a type of headache called a thunder clap headache. Where the onset to peak intensity occurs almost instantaneously, which is, always needs to be evaluated. Most of the time, thunderclap headaches are, turn out to be benign. In the old literature, they used to call them crash migraines but they still need to be evaluated properly. To rule out significant underlying problems. The other c, category is people who have abnormal neurological symptoms or abnormal neurological findings on their examination, and those always need to be taken seriously and evaluated properly. Occasionally, people have posture or positional or insertional related headaches. That for the most part almost always turn out to be benign. But still, they're an atypical feature that would require, suggest that they might need additional testing to be safe. Lastly, people that have a history of recurrent headaches. If their headache patterns shifts, changes, or is modified, or they develop a new type of headache, always require an investigation to figure out why things have changed. When you look at the one year prevalence of the most common headache conditions. We talk about migraine episodic tension headache, and chronic daily headache. You can see from this slide that episodic tension headache is by far the most common, migraine second, and chronic daily headache third. And women are affected more frequently. Than men. You might ask why is this important or why are headache disorders important? And you can see that in the case of migraine, you know, 20% of the population of women, six percent of men, is actually more common than diabetes. And asthma combined. And in 2000 the world health organization listed migraine as the number one disabling condition in the world. That's because it's so very common, and typically people have a significant im, it has a significant impact on their daily functioning, their functioning at home. At work and just recreational life so it's really is a quite disabling condition for some people. So it's very important to understand and probably even more important to prevent. Just a couple words on chronic daily headache, in the field of pain most people. Think of acute pain and then chronic pain is just when acute pain hasn't healed or gotten better and it's just been present for over three months. In the headache terminology, we use episodic headache meaning on that has a recurrent pattern of headaches that can be for the last month or it can be for the last ten years, but they're episodic in nature, and they resolve. We talk about chronic headaches, we're talking about people that have headaches more frequently than 15 days per month and when they have em, they last for over four hours each day. And so, you can actually have a person that's had headaches for twenty years and still have episodic headaches. Or a person that's only had headaches for three months and have chronic headaches. When we look at the diagnostic breakdown, and chronic and daily headaches, the slide shows that about 80% are related to chronic migraine. Or the transformation of episodic migraine to chronic migraine. Chronic tension type headache is the other big category of chronic daily headache. And then a smaller group of people will suffer from either chronic cluster headache, chronic. A new, daily, persistent headache, or hemicrania continua. [BLANK_AUDIO] When we move from episodic to chronic headache, we begin to, the discussion of talking about comorbid conditions that impact. Headache and you can see from this list that anxiety and depression are critical factors for that are present concurrently with people with headache. They can either have been depressed before the headaches became worse or the depression and anxiety can be reactive. To the headache condition itself, type a personality patterns which is that high achiever, goal oriented, driven individual is a risk factor for the progression of episodic to chronic headache. And the progression occurs at a rate of about 2.5% per year from episodic migraine to chronic migraine. [BLANK_AUDIO].
